Depression, C-reactive Protein and Two-year Major Adverse Cardiac Events in Men after Acute Coronary Syndromes

• Published in: Biological psychiatry (1969) 2007-08, Vol.62 (4), p.302-308
• Main Authors: Frasure-Smith, Nancy, Lespérance, François, Irwin, Michael R, Sauvé, Claude, Lespérance, Jacques, Théroux, Pierre
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Angina, Unstable - blood; Angina, Unstable - immunology; Angina, Unstable - psychology; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein - analysis; Cardiology. Vascular system; Chi-Square Distribution; Coronary heart disease; CRP; Depression; depressive disorder; Depressive Disorder - blood; Depressive Disorder - complications; Depressive Disorder - immunology; Female; Follow-Up Studies; Heart; Humans; inflammation; Inflammation Mediators - blood; Interleukin-6 - blood; Male; Medical sciences; Middle Aged; Mood disorders; myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - immunology; Myocardial Infarction - psychology; Myocarditis. Cardiomyopathies; Prognosis; Proportional Hazards Models; Prospective Studies; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Sex Factors
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2006.09.029

Background We investigated the impact of depression and inflammatory markers, assessed 2 months after acute coronary syndrome (ACS), on major adverse cardiac events over 2 years (MACEs; cardiac death, survived myocardial infarction, survived cardiac arrest, and nonelective revascularization). Methods Depression symptoms (Beck Depression Inventory-II; BDI-II), major depression, C-reactive protein (CRP), interleukin-6, and soluble intercellular adhesion molecule were assessed in 741 ACS patients (including 602 men). Results Some 102 (78 men) experienced at least one MACE. Beck Depression Inventory-II scores of ≥14 predicted MACEs ( p = .007). The increase in risk was marked in men (hazard ratio [HR] = 1.96, 95% confidence interval [CI] = 1.24–3.09, p = .004), with little evidence of a relationship in women ( p = .85). Subsequent analyses were limited to men. Results were similar after covariate adjustment (HR = 1.72, 95% CI = 1.07–2.77, p = .024). C-reactive protein levels were also associated with increased MACE risk (adjusted HR for CRP ≥ 2.0 mg/L = 1.67, 95% CI = 1.07–2.62, p = .025). C-reactive protein levels and BDI-II scores interacted in predicting MACEs. Men with both BDI-II scores of ≥14 and CRP of ≥2.0 mg/L experienced an increase in risk similar to those with only one of these factors. Conclusions In men assessed 2 months after ACS, depression and CRP are overlapping prognostic risks. Patients with either risk may benefit from similar therapies.